How is splenomegaly characterized in Epstein-Barr virus (EBV) infectious mononucleosis (mono) and how is it differentiated from other conditions that also present with splenomegaly?

Updated: Sep 20, 2018
  • Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Splenomegaly may be classified according to the degree of splenic enlargement and whether it occurs alone or as part of generalized lymph node involvement. Although, in rare cases, splenic rupture is the initial clinical manifestation of EBV infectious mononucleosis, the splenomegaly of EBV infectious mononucleosis is usually accompanied by localized or generalized adenopathy. In the absence of splenic rupture, patients with EBV infectious mononucleosis do not present with isolated splenomegaly in the absence of other findings. The many systemic disorders that manifest as splenomegaly in the absence of lymphadenopathy, eg, brucellosis, lymphoma, and subacute bacterial endocarditis (SBE), are readily differentiated from EBV infectious mononucleosis with splenic enlargement.

Generalized adenopathy may occur with many infectious and noninfectious diseases, most commonly group A streptococcal infections, systemic lupus erythematosus (SLE), and sarcoidosis. Because the spleen is part of the RES, most cases of generalized adenopathy are accompanied by splenomegaly. However, most disorders with presentations that predominantly involve generalized adenopathy rarely involve splenomegaly, and, when present, the splenic enlargement is not prominent (eg, generalized adenopathy is common in SLE, but splenomegaly is uncommon). Generalized adenopathy with prominent splenomegaly should suggest EBV infectious mononucleosis. A diagnosis of EBV infectious mononucleosis in the absence of bilateral posterior cervical adenopathy with or without generalized adenopathy or splenomegaly should raise suspicion of the diagnosis.

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